Presentation Details
| Time to stable therapeutic anticoagulation using weight-based IV heparin dosing clinical decisions support program Keri S.Kim, Jean Lee, Miranda Hart, John Garofalo, Jeffrey J.Mucksavage. University of Illinois Chicago College of Pharmacy, Chicago, IL, USA |
Abstract
Heparin is a high alert medication due to its potential to cause significant harm in hospitalized patients. National Patient Safety Goals set by The Joint Commission recommend that institutions develop IV heparin guidelines to assist with dosing and management of bleeding. Currently there are no recommended target metrics designed to maximize efficacy and safety with IV heparin. Some target metric proposals include achieving therapeutic anticoagulation within 24 hours of heparin initiation and utilizing clinical decision support included in electronic health record software. The purpose of this study is to determine compliance with the IV heparin dosing protocol at the University of Illinois Hospital and Clinics (Ul Health) since implementing a weight-based clinical decisions support (CDS) program. Additionally, time to stable therapeutic IV heparin will be described. This is a retrospective observational study. Patients were randomly selected between 6/1/2021 to 12/31/2022 if they were managed per the IV heparin dosing protocol for more than 24 hours. A therapeutic heparin dose was defined as the dose associated with aPTT range of 60-100 seconds, and a stable therapeutic heparin dose was associated with two consecutive aPTTs in the aPTT range 60-100 seconds. The primary outcome of this study is to determine time to stable therapeutic anticoagulation using IV heparin. Other outcomes include percent of patients achieving stable therapeutic anticoagulation, percent of patients achieving stable therapeutic anticoagulation within 24 hours of initiation, and the percent of therapeutic vs sub- or supra- therapeutic anticoagulation with every IV heparin doses. A total of 68 patients were included. The average age was 63 years, and the majority indication for heparin therapy was for the management of venous thromboembolism (68%). Average weight and body mass index were 85 kg and 29.8 kg/m², respectively. The total number of hours on IV heparin therapy was 6295.6 hours, and a total of 699 doses were evaluated. Stable therapeutic heparin was achieved in 69% of patients. Only 15% of patients achieved stable therapeutic heparin within 24 hours of initiation. Mean time to stable therapeutic anticoagulation was 40 hours. Heparin dosing protocol deviation occurred in 11% of all heparin dosing. In a total of 699 doses evaluated, 41% were therapeutic, 31% were sub-therapeutic and 18% were supra-therapeutic. One thrombotic and one bleeding event occurred during IV heparin therapy. Most patients were not discharged with oral anticoagulation therapy (53%), and patients who were discharged with an oral anticoagulant, apixaban was most frequently prescribed (35%). In conclusion, the IV heparin dosing protocol at UI Health led to achieving stable therapeutic anticoagulation on average 40 hours after initiation. Since the compliance of IV heparin dosing protocol was high, the next step is to revise IV heparin dosing protocol to achieve stable therapeutic anticoagulation faster and to maintain it longer.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Content Locked. Log into a registered attendee account to access this presentation.